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He lists thirteen of the categories in the manual: degenerative changes in the central nervous system (includes Alzheimer's and senile dementia, among others); vascular disorders (includes stroke and others); metabolic disorders (includes diabetes, renal diseases, electrolyte disorders, and others); space-occupying lesions (includes tumors and others); head trauma; mental retardation; epilepsy; infections; intoxication (includes alcohol, lead, and others); hydrocephalus; heat stroke; blood disorders; miscellaneous organic disorders (includes sarcoidosis, multiple sclerosis, and others).
"Even these disorders have emotional components that are difficult to sort out from purely organic factors," Dorman says. "For example, if someone had multiple sclerosis, she'd have lesions in the brain and also have every reason to be depressed. Which is which? Not possible to say for sure."
Dorman says 50 percent of the world's population meets the criteria of one of the manual's diagnoses. "What, then, are the psychiatrists saying?" the psychiatrist asks. "They're saying that fifty percent of the population is abnormal. Is that possible?"
Dorman argues with the Western psychiatric establishment's notions about cause and effect. "If someone's father or mother dies, that person gets depressed, you do a PET scan of his brain or studies and you'll find out that, yep, it looks similar to other people who are depressed," he says. "The other people in psychiatry say, 'Oh, no, it's just his brain that's broken.'" Psychiatry argues that these brain abnormalities cause mental disorders, but Dorman thinks that's backward. "That's a silly argument, since everybody knows that deaths and loss cause people to be unhappy. Just to say that people who are sad have broken brains is kind of silly."
Lurie is more willing to defend the status quo, though he acknowledges that it has drawbacks. "The [manual] is the current amount of scientific experience we have," he says. "There is also clinical experience, which isn't quite so scientific, but it's what we have. And it evolves. They're writing a new [manual] that's going to be different than the last one. Their committee's getting together and discussing the same issues, saying 'This isn't validated, maybe we should think about it a different way.' Or 'There's new scientific information that we didn't have ten, fifteen years ago when we developed the previous one.'"
The symptoms that led to Crystal Haviland's diagnosis could be construed as understandable reactions to personal trauma. Physically and emotionally abused from the age of four, she says, she started hurting herself at age six or seven, slamming her head against the wall right around the same time she was first sexually abused. She began experiencing "pretty extreme depression" when she was eleven, and soon became anorexic. As her depression dovetailed with an adolescent surge of hormones, she graduated to more sophisticated methods of self-harming. Early in her fifteenth year, she became suicidal and was hospitalized, largely against the wishes of her mother and stepfather. She said they had "the kind of attitude that some parents have where they just think you want attention. And I was like, 'No, I really wanna kill myself. '"
Haviland, now 26, was admitted to an institution and placed on suicide watch. "Every ten minutes they'd shine a flashlight in my face, even when I was trying to sleep," she remembers. Because she had copped to drinking and smoking pot, she was put into an adult drug program and forced to attend Narcotics Anonymous meetings. Her roommate in the institution, who was suffering from an eating disorder, would often ask Haviland to stand guard while she did sit-ups in an effort to work off more weight. The whole thing was just ... depressing.
"None of it was really helpful as far as getting any true care or treatment," Haviland says. She got good marks on her chart, though, and was released after two weeks. After a short-lived spell of calm at home, she moved out just before turning sixteen, focusing her energies on graduation and survival.
Haviland's official diagnosis is bipolar II. Psychiatric professionals usually prescribe her antidepressants and, for the anxiety attacks triggered by her extensive history of trauma, antianxiety medications. In her short life, she has taken the antidepressants Prozac and Celexa; the anticonvulsant Depakote; the antianxiety med Ativan, and, of course, the mood stabilizer lithium carbonate; not to mention the self-medicating that has been a factor in her life since she was twelve, most dangerously with speed for a few years after first moving to California. Now, though, Haviland is clean and sober -- no lithium, no booze, no antidepressants. She says it was a pretty easy decision to make, given that she is pregnant.
"It's been very interesting," she says with a laugh. For one thing, she isn't used to eating so healthily and so regularly. But now she is feeding her body good stuff at regular intervals, and experimenting with the effects of Chinese herbs and natural compounds such as amino acids and Omega-3 polyunsaturated fatty acids. She's starting to suspect that her psychological problems may have something to do with thyroid dysfunction, but she's not averse to the idea of getting back on certain medications if absolutely necessary. She wants to do what's best for herself and her child, and so she educates herself constantly.
What Haviland has found most helpful are the various communities providing her with support. The slender, generously tattooed activist lives in a collectively owned house in Berkeley with five housemates, one of whom is her partner. She is part of the Nabolom Bakery collective. She is in therapy. And she is a member of the Bay Area Radical Mental Health Collective.
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